Enhancing NM Public Schools Vision Screening Programs

Transcription

1 Enhancing NM Public Schools Vision Screening Programs Bryson McCool Secretary/Treasurer Dr. Todd Goldblum, MD Medical Advisor NM Lions Operation KidSight, Inc.

2 Topics What is NM Lions Operation KidSight, Inc.? Why Conduct Vision Screenings of Children? Children s Vision Problems and Amblyopia Vision Screening for Amblyogenic Risk Factors Save Our Children Sight Fund Administration Reasons to Consider Using NMLOKS Services in Public School Screening Programs For Pre-K, K, & 1 st Grade Children 2

3 What is NM Lions Operation KidSight, Inc.? NMLOKS, Inc. 501c3 Organization 3 Executive Directors 7 Directors Sec./Treas. Medical Advisor NMLOKS, Inc., Central Office Program Manager Ms. Brenda Dunn 22 Lions Screening Teams Las Cruces, NM Screen 3-7 year old children for amblyogenic risk factors Currently servicing public schools, Head Starts, private/charter schools, child care centers, and health fairs across NM Save Our Children Sight Fund In 1925 at their annual convention, Helen Keller in her keynote speech posed the following request to Lions Clubs International (LCI): The opportunity I bring to you, Lions, is this: To foster and sponsor the work of the American Foundation for the Blind. Will you not help me hasten the day when there shall be no preventable blindness; no little deaf, blind child untaught; no blind man or woman unaided? I appeal to you Lions, you who have your sight, your hearing, you who are strong and brave and kind. Will you not constitute yourselves Knights of the Blind in this crusade against darkness? Her challenge was accepted by Lions. 3

4 NMLOKS, Inc., Screening Programs Status Gallup Window Rock Farmington Evening Rio Rancho Host Alb. Rio Grande & Northeast s Los Alamos X Santa Fe Capital City Taos X Raton Greater Las Vegas Moriarty Clovis Evening Ruidoso Noon Roswell Lions Clubs Socorro Lea County s Silver City & Women s Club Deming Dona Ana County s Alamogordo Breakfast Carlsbad Downtown Artesia Downtown X - Future Program Note that NMLOKS, Inc., has roving screening teams that are able to go into out of the way communities not easily covered by other teams. 4

5 Why Conduct Vision Screenings of Children? 86% of children entering 1 st grade have never had an eye exam % of children enter school with vision problems that can affect their learning development and progress. 70% of school-age children who have a learning disability have some form of visual impairment. 1.8 million children in US have vision impairment from amblyopia yet only 1 in 3 are screened. 2.9% of adults have permanent vision loss due to untreated amblyopia. 95% of children s visions disorders can be corrected if detected early. Children are unaware they have a vision problem (they think everyone sees like they do). Normal visual development proceeds only if the brain receives an EQUALLY CLEAR image from EACH EYE. Vision screening is much more cost effective than sending every child to the eye doctor each year. The best defense is early detection! 5

6 Children s Vision Problems and Amblyopia Conditions Strabismus the eyes are crossed inward or turned outward. Anisometropia there is a major difference in refractive power between the two eyes caused by myopia, hyperopia, or astigmatism. Anything that prevents light from entering the eye, e.g., congenital cataract, drooping of one eyelid (ptosis), eye injury, etc. Aniscoria the difference in the size of the pupils is greater than 1.0mm. Amblyopia is the most common cause of monocular blindness (i.e., partial or complete blindness in one eye). AMBLYOPIA The brain favors one eye over the other. The weaker eye is ignored and it is not adequately stimulated resulting in the nerve pathways between the eye and brain not maturing normally. While only 2 to 3% of children will actually develop amblyopia, the risk factors which can cause amblyopia are generally present in 12 to 15% of the 3 to 6 year old population. Treatment Refractive error can be corrected by glasses, contact lenses or, if appropriate, lasik. Wearing an eye patch over the stronger eye is a hallowed treatment for amblyopia. Another option is atropine eye drops to blur the vision temporarily in the stronger eye. Treatment of strabismus may involve surgical correction of the eye muscle imbalance. 6

7 Vision Screening for Amblyogenic Risk Factors Early Detection of Amblyogenic Risk Factors Benefits Benefits Screening with a Photoscreener Efficacy of amblyopia treatment decreases with increasing age so catching it early is better. Treatment will prevent permanent vision loss. The US Preventive Services Task Force (USPSTF) has specifically endorsed the use of photoscreening with autorefraction modalities for the detection of ambylogenic risk factors in the 3 to 5 year old age group. Over 6 million Americans have amblyopia and it is responsible for loss of vision in more people under the age of 45 than all other causes combined. 7 (Journal of AAPOS 2013;17-4-8) Can significantly increase the currently low screening rates of children, especially 3-5 year olds. Can facilitate vision screening in children who are difficult to deal with. Little cooperation is needed from the child. Measurement results are analyzed by the computer for amblyogenic risk factors (based on referral criteria optimized for specificity and sensitivity and reviewed by Dr. Todd Goldblum, MD), and positive findings are noted. Children who do not pass the screening are referred for a comprehensive eye examination. 7

8 Vision Screening Devices Used by NMLOKS Plusoptix S09 Welch-Allyn SPOT The Plusoptix S09 and the Welch-Allyn SPOT combine performing a simultaneous autorefraction on both eyes with a photoscreening. Autorefracting both eyes simultaneously is preferable to autorefracting one eye at a time because it ensures each eye is accommodating equally and is theoretically better at detecting anisometropia (unequal focus between the eyes). The two systems also perform a photoscreening which has benefit in detecting media strabismus and opacities (e.g., cataracts). Use of infrared light means children don t shy away from a bright visible flash. Screening can be very quick taking only about 2-3 seconds to acquire multiple radial digital photoscreening images which the computer interprets. Provide useful measurement data for both eyes including the full estimate of glasses power (sphere, cylinder and axis), pupil size, and estimated ocular alignment horizontal and vertical. 8

9 Example of a Plusoptix S09 Measurement Screen Refractive Errors identifies possible hyperopia/farsightedness (+) and myopia/nearsightedness (-). Cylinder Indicates a corneal irregularity or astigmatism that causes blurriness. Corneal Reflexes Indicates the degree to which an eye deviates from the parallel eye position. If greater than 10 degrees, strabismus may be present. Pupil Size If the difference in the size of the pupils is greater than a designated threshold, it indicates aniscoria may be present. Anisometropia If the difference in refractive error or cylinder value of each eye is greater than a designated threshold, anisometropia may be present. Ptosis A drooping eyelid which partially covers the pupil. Cataracts Can distinguish media opacities in the eye such as cataracts. 9

10 Example of a Plusoptix S09 Measurement Report Provides an easy to understand specification of possible vision problem(s) the child may have. Printed on site and provided to the school nurse or Head Start administrator after screening session. The school nurse or Head Start administrator contacts the parents of the referred child to alert them their child has been screened and the results reveal there may be a vision problem and should have a full eye examination. A copy of the measurement report is given to the parents. School nurses and parents are advised that NMLOKS, Inc., can provide funds for eye exams and glasses for referred children who are not covered by private insurance or Medicaid. School nurses and Head Start administrators provide referral follow up information to NMLOKS, Inc., which is necessary to determine that the screenings are not over-referring children. 10

11 Example of Follow Up Results from a NMLOKS Screening Team Table below shows follow-up results from 18 of the 23 Las Cruces elementary schools screened in School nurses had almost a 83% rate of getting referred children to an eye professional. Percent of referred children who did not need treatment (False Positive Rate) was 9.83%. Screening Site Kids Screened # Referrals % Referred # of Referred Who Saw Eye Doc # No Treatment Needed # Who Got Glasses # Moved # Appts Pending # of Ref. Children Did Not See Eye Doc Followup Success % False Positive Rate (%) Cesar Chavez Elementary % % 3.33% Conlee Elementary % % 7.14% Desert Hills Elementary % % 11.76% MacArthur Elementary % % 7.69% Fairacres Elementary % % 8.33% Hermosa Hgts Elementary % % 15.00% Hillrise Elementary % % 0.00% Conlee Elementary % % 7.14% White Sands Elementary % % 33.33% Valley View Elementary % % 11.11% Mesilla Elementary % % 33.33% Mesilla Park Elementary % % 0.00% Alameda Elementary % % 20.00% Univ. Hills Elementary % % 20.00% Dona Ana Elementary % % 23.08% Monte Vista Elementary % % 0.00% Sonoma Elementary % % 0.00% Loma Heights Elementary % % 0.00% % % 9.83% 11

12 Comparison of Acuity Vision Testing & Automated Vision Screening Characteristic Conventional Acuity Testing Autorefractor/ Photoscreener Screen infants & preverbal children No Yes Screen nonverbal or developmentally challenged children Yes w/difficulty Yes Time To Screen (Min.) 5+ < 1 Detect amblogenic risk factors Myopia & Hyperopia Myopia, Hyperopia, Astigmatism, Strabismus, Aniscoria, & Anisometropia Child's cooperation level required High Low Ability to control accommodation to get a realistic measurement of hyperopia None Moderate to High 12

13 Save Our Children Sight Fund Began 1 Jan 2008 based on New Mexico Statute Authority Save Our Children's Sight Fund (SOCSF) option. NM residents can donate $1 or $5 to the Fund when renewing vehicle registration. NM Save Our Children s Sight Fund Money in the fund is appropriated to NMDOH, which shall administer the fund for the purpose of development and implementation of a vision screening program making vision screenings and follow-up comprehensive examinations available to New Mexico children regardless of family income. Contract between NMDOH and NMLOKS, Inc., signed January 2015 to administer the SOCSF. NMLOKS, Inc., Program Manager will coordinate with school nurses to identify 3-18 year students who have been referred by nurse s or KidSight screenings and who are not covered by Medicaid or other insurance. NMLOKS will cover 3-7 year old students while SOCSF will cover 8-19 year olds. NMLOKS, Inc., Program Manager will coordinate with eligible student s parents to set up exam and provide glasses if needed. 13

14 Reasons to Consider Using KidSight Services in Vision Screening Programs For Pre-K, K, & 1 st Grade Children Cost effective no cost to school districts. Relatively quick procedure 1 child per minute. May free up school nurses from time spent for required annual acuity screening more time for referral follow up. Can detect amblyogenic risk factors. Can easily screen developmentally challenged and nonverbal children. KidSight Program is available across NM. Many studies have validated the efficacy of vision screening. The ultimate goal of NMLOKS, Inc., is to provide every NM child ages 3-7 years old with the opportunity for a free vision screening to ensure there are no vision roadblocks to interfere with their ability to read and learn. 14

15 NMLOKS, Inc., Contact Information Brenda Dunn, Program Manager NMLOKS, Inc., Central Office 1501 North Solano Drive Las Cruces, New Mexico Phone: Fax: Bryson McCool, Secretary/Treasurer 5557 Red Fox Rd. Las Cruces, NM Phone: (c) Fax:

16 NMLOKS, Inc., Contact Information Screening Team/Location Screening Team Director Phone # Address Alamogordo Breakfast Chuck Galusha chuckfg1@gmail.com Albuquerque Rio Grande Lucky Sells luckynjanice@hotmail.com Artesia Terry Maupin termaup@outlook.com Carlsbad Downtown Jennifer Long jjlong@sandia.gov Clovis RandyRhue r.rhue@live.com Crane Reading Program George Mulholland georgemulholland@comcast.net Deming Doc O'Connell ocys1@q.com Dona Ana County #1 Hector Giron hectorgiron8@gmail.com Dona Ana County #2 Bryson McCool brymccool@gmail.com Executive Director Curt Dimberg cdimberg@valornet.com Farmington Marilyn Montoya Marilyn_Montoya@yahoo.com Gallup Johnty Cresto lionjohnty@yahoo.com Greater Las Vegas Maryann Sanders bjmsand@yahoo.com Lea County Roy Robinson royjuanice@aol.com Los Alamos Stan Moore Moriarty Don Trumbull kdbull@q.com Northeast Alburquerque Miriam Stucker miristuc@yahoo.com Raton Ursula Garcia urs.g@live.com Rio Rancho Liz Thomas lizchis@cybermesa.com Ruidoso Noon Mike Schattner mschattner@yahoo.com Santa Fe Capital City Rose Himrod lionrosesantafe@aol.com Silver City Lion/Womens Club Carolyn Havens chavens@q.com Socorro/Los Lunas Jean Bodensteiner lionjeanb@uahoo.com 16 Taos William Waugh lorrybill@msn.com